1. Field of the Invention
The present invention relates generally to a billing and records system. More particularly, though not exclusively, the present invention relates to a code-driven computerized system for health care billing that places the responsibility for billing on the health care provider at the point of service. The present invention includes variations for other service industries in which it is desirable to place primary responsibility for billing and records keeping on the service provider. Other industries include, but are not limited to the fields of law, accounting, dentistry, architecture, and any other service-type industry where clients demand service providers be accountable for their time and services.
2. Problems in the Art
In 1966, the American Medical Association developed a system it calls Current Procedural Terminology (CPT). The CPT system is used by doctors and other health care providers to ensure uniformity in the description of services performed through the use of a common set of codes and descriptors. Unfortunately, the CPT is updated every year and in the year 2000 is expected to utilize 7,755 codes and descriptors. Such constant updating of so many codes requires care providers to spend countless hours ensuring the proper codes for services provided are being utilized correctly. With the passage of the Medicare Catastrophic Coverage Act of 1988, it became a mandatory requirement to use diagnostic coding of the International Classification of Diseases, 9th Revision, Clinical Modification, (ICD-9CM) published by the Practice Management Information Corporation with a new revision available approximately September 15th of each year. Proper coding is the essential component of billing systems in order to satisfy the needs of clients relative to insurance companies, health maintenance organizations, and federal government programs such as Medicare and Medicaid.
Currently, there are multiple medical billing systems in place in which a care provider, such as a doctor, nurse, or allied health care provider, must manually enter coded patient care data on paper sheets prior to placement into a computer system. A billing clerk or other non-care providing personnel is then required to convert codes into a patient specific bill. This procedure allows for too many errors and places the ultimate responsibility for proper billing of clients on clerks and other personnel instead of upon the provider of services. As the health care provider is legally responsible for their submitted codes, it is desirable to facilitate the proper coding and billing for the person performing the services, i.e. the care provider.
Prior art systems which have attempted to correct this situation have allowed care providers to input patient specific coding in various ways. One prior art method of properly coding patient services was to use a preprinted super bill, such as the DocuScan®. A super bill, as commonly known in the art, allows the care provider to simply select the appropriate codes for the services performed via a Scantron® type sheet. However, due to the great number of codes, the super bill only contains pre-selected codes. Any additional or supplemental codes must be entered and selected manually by the care provider or an assistant and manually transferred into the billing system. Further, the super bill requires the care provider to take time filling in circular indicators and finding exactly what codes should be marked for the services performed. Once completed by the care provider, the super bill is then submitted to other personnel and a patient specific bill is generated.
Still other prior art systems allow doctors to use a remote terminal and batch in, or download from a main terminal, all of the patient records for patients to be seen during the day. Upon download, the care provider can then input which services were performed for the patients on the remote terminal. At the end of the day, the care provider must then batch out, or upload to the main terminal, all the patient records in one action. Upon receiving the patient records, including the services performed, the main terminal can then be used to generate individual patient bills. This prior art system does not allow for the real-time generation of an individual bill or correction of erroneously selected codes prior to the patient's departure from the care provider's office. A further problem with such a prior art systems has been the inability to edit a patient's data once that data has been entered and before the data is transmitted or to input a new patient into the system at the point of care via the remote computer.
Still further yet, such systems doe not allow the care provider to easily customize the diagnosis and procedure code screens with those codes most frequently used in the care provider's particular practice or field of specialty; such customization would require additional programming with great cost in terms of time and money. Nor do the prior art systems permit the care provider to search on-line for a particular code.
As on-line, or Internet based health-care information is becoming more and more prevalent, and more and more patients are on-line, it is desirable to have a system which is capable of having an on-line presence. Currently, WebMD.com provides information on physicians, diseases, and other medically related fields. However, the site does not allow patients to review their records or billing on-line. Further, the site does not allow care providers to provide such information.
Finally, remote computer systems are currently limited to laptop or desktop units which are then hardwired into the walls at the point of care and thereby wired to the main terminal. This prevents the care provider from entering data from any location other than where the computer has been placed. It is therefore desirable to provide a wireless, lightweight remote terminal system which allows the care provider to freely roam about and enter data anywhere at the point of care. It is further desirable to be able to access the host system even when out of the care provider's home office. In short, these prior art systems lack the functions and flexibility to be of significant assistance to the care provider. It is therefore desirable to have a system which overcomes the deficiencies found in the prior art, solving the aforementioned problems.
There is therefore a need to have a computer system that places responsibility for individual patient or client information, services provided, and billing records with the service provider at the point of service and allows the service provider to provide the patient or client with a bill upon the patient's or client's departure. In a medical application, there is a need to have a code driven computer system which accomplishes the above.